These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of Human T‐cell lymphotrophic virus 1 (HTLV)‐1 in the pre‐ and post‐transplant period. HTLV‐1 is an oncogenic human retrovirus rare in North America but endemic in the Caribbean and parts of Africa, South America, Asia, and Oceania. While most infected persons do not develop disease, <5% will develop adult T‐cell leukemia/lymphoma or neurological disease. No proven antiviral treatment for established HTLV‐1 infection is available. The effect of immunosuppression on the development of HTLV‐1‐associated disease in asymptomatically infected recipients is not well characterized, and HTLV‐1‐infected individuals should be counseled that immunosuppression may increase the risk of developing HTLV‐1‐associated disease and they should be monitored post‐transplant for HTLV‐1‐associated disease. Currently approved screening assays do not distinguish between HTLV‐1 and HTLV‐2, and routine screening of deceased donors without risk factors in low seroprevalence areas is likely to result in significant organ wastage and is not recommended. Targeted screening of donors with risk factors for HTLV‐1 infection and of living donors (as time is available to perform confirmatory tests) is reasonable.
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